CARDIOLOGY

ResponseBe able to pick VT
Basically if regular and 160 it will be VT
If its 250 ish probs be AF with Accessory pathway and they want you to know not to give adenosine.

ResponseFentanyl 25-50 mics – CVS stable, analgesic, cons – resp depression
Midazolam 1-2mg – CVS stable, anxiolysis, amnesic – cons resp depression, no analgesia
Ketamine 10-20 mg – CVS stable, Analgesia – cons resp depression, apnoea, tachycardia

ResponseSYNCHRONISED Cardioversion
200J (Answers range from 100J to 200J)
Standard vs AP pads – need 10cm clear of PPM box
Question asked both as defib settings, and how would you do it (also needs consent/sedation)

ResponseMachine – check power/battery. ? defib charged, leads/ ? sync working (particularly at very high ventricular rates)
Patient – check pads
Operator – Check correct technique
Repeat attempt when safe to do so.

ResponseSedation effect
Stunned myocardium
NSTEMI
Sepsis

ResponseRegular
Very broad QRS (>120-160 ms – answers seem to vary here)
Rate 140-200 (not conclusive)
Uniform QRS complexes within each lead – Each QRS is identical (Except for capture/fusion beats)
Absence of typical RBBB or LBB morphology
Extreme axis (northwest axis
Capture beats – SA node transiently captures ventricle producing a normal duration QRS
Fusion beats – Sinus and ventricular beat coincide to produce hybrid complex
Positive or negative concordance throughout the chest leads (ie: V1-V6 entirely positive or entirely negative QRS complexes)
Josephson sign – notching near the nadir of the S wave
Brugada’s sign – onset of QRS to nadir of S is >100 ms
RSR’ taller L rabbit ear morphology (Most sensitive, note in RBBB the R rabbit ear is bigger)
VT producing condition on prior ECG such as brugada, STEMI, or ARVD
Similar ECT to past episode of VT diagnosed by EP testing
Verecki criteria in lead aVR



High yield - taken From LITFL, points from answers in bold

ResponseNote: brugada criteria different to Brugada sign different to Brugada syndrome different to Brugada pattern. To top it off there are 2 famous cardiologists called “Brugada” . Say Brugada 5 times fast

There are 4 steps, if confirmed then stop, if not move on:

• Absense of RS complex anywhere V1-V6 = VT
• Onset of R to Nadir of S in any precordial lead >100 ms = VT
• AV dissociation = VT
• Morphology criteria for VT present both in leads V1-2 and V6 – must suggest VT (otherwise Dx is SVT)

Sn = 89%, sp =59%

ResponseVT
SVT with aberrancy (Due to BBB)
SVT with WPW
Pacemaker mediated tachycardia
Metabolic derangements eg: Hyperkalaemia
Sodium channel blockade – Eg: TCA overdose

ResponseHistory favouring VT

• Age >35
• Known structural heart disease
• Known ischaemic heart disease
• Prior MI
• Hx CCF
• Known cardiomyopathy
• FHx sudden cardiac death

ResponseHypotension
Pulmonary oedema
Altered conscious state
Ongoing ischaemic chest pain

Response Answer was observation vs drug vs shock.

ResponseDrugs

• Tricyclics, Digoxin

Ischaemia

• ST changes on reversion ECG, hx IHD, preceeding chest pain

Electrolyts

• Hypokalaemia, hypomagnesaemia

Structural hear disease

• Congenital cardiomyopathies, infiltrative disease

Primary arrhythmia

• Hx cardiomyopathy eg: ARVD (? Brugada also reasonable)

ResponsePeripartum cardiomyopathy (last month of pregnancy)
All the other stuff above.

ResponseCopy table in from p 47 – it’s fkn money

ResponseIHD/MI/Stents/CABG
Prior VT
Cardiomyopathy/reduced LVEF
Strucrual heart disease
Sudden cardiac death (HOCM, Brugada)

ResponseAmiodarone 5mg/kg
Lignocaine 1mg/kg
Sotolol 1mg/kg
Magnesium 10mmol
Treat underlying cause (eg DAPT and cath lab for STEMI)
(Procainamide 50 mg/min is mentioned. Its not readily available in Aus. Write if desperate)

ResponsePASTED – see SVH 2021.1-11 if wanting more